Provider Demographics
NPI:1952536138
Name:SMITH, JAMIE RENEE (APRN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:RENEE
Other - Last Name:CHARTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:8906 SPANISH RIDGE AVE
Mailing Address - Street 2:STE. 202
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1304
Mailing Address - Country:US
Mailing Address - Phone:702-577-1622
Mailing Address - Fax:702-912-4994
Practice Address - Street 1:1950 PINTO LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4017
Practice Address - Country:US
Practice Address - Phone:702-438-2229
Practice Address - Fax:702-385-0982
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001124363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1952536138Medicaid
NVAPRN001124OtherSTATE APRN LICENSE
NV1952536138Medicaid
NVV111370Medicare PIN